Atopic Dermatitis (Eczema)

Topic Overview

What is atopic dermatitis?

Atopic dermatitis, sometimes called eczema, is a
skin problem that causes dry skin, intense itching, and
then a red, raised rash. It's most common in babies and children. It cannot be spread from person to person.

Some children with atopic
dermatitis outgrow it or have milder cases as they get older. Also, a person may get atopic dermatitis as an adult. For some people, atopic dermatitis may be a long-lasting (chronic) skin problem that requires more than one treatment.

Certain foods, such as
eggs, peanuts, milk, wheat, fish, or soy products, if you are allergic to them. Food allergies trigger atopic dermatitis more commonly in babies and children than in adults.

Skin infection.

What are the symptoms?

The main symptom of atopic
dermatitis is itching, followed by rash. The rash is red and patchy. It may be
long-lasting (chronic) or may come and go (recurring). Tiny bumps that look like little blisters may appear and ooze fluid or crust over. Scratching can cause the sores to
become infected. Over time, a recurring rash can lead to tough and thickened
skin.

Mild atopic dermatitis affects a small area of skin, isn't very itchy, and usually goes away with moisturizer. Severe atopic dermatitis covers a large area of skin that is very itchy and doesn't go away with moisturizer.

People tend to get the rash on different parts of the body,
depending on their age. Common sites include the face, neck, arms, and legs.
Rashes in the groin area are rare.

How is atopic dermatitis diagnosed?

A doctor can
usually tell if you have atopic dermatitis by doing a physical exam and asking
questions about your past health.

Your doctor
may advise allergy testing to find the things that trigger the rash. Allergy
tests can be done by an allergist (immunologist) or dermatologist.

How is it treated?

Mild atopic dermatitis can be treated at home.

Moisturize often. Creams and ointments work better than lotions.

Avoid things that trigger rashes, such as harsh soaps and
detergents, dander, and any other things you are allergic to.

Control scratching. You may want to cover the rash with a bandage to keep from
rubbing it. Put mittens or cotton socks on your baby's hands to help prevent
him or her from scratching.

Use medicine prescribed by your
doctor.

Bathe with lukewarm water and for short
periods.

But if your symptoms are bothering you and aren't getting better, see your doctor. Getting medical treatment early may keep your symptoms from getting worse.

In severe cases, your doctor may prescribe pills or give
you a shot to stop the itching. Or you may get ultraviolet (UV) light treatment
at a clinic or doctor's office.

Cause

The cause of
atopic dermatitis isn't known. But most people who have it have a personal or family history of allergies, such as
hay fever (allergic rhinitis). The skin
inflammation that causes the atopic dermatitis rash is
considered a type of
allergic response.

Temperature changes, such as a suddenly higher temperature. This may bring on sweating, which
can cause itching. Lying under blankets, entering a warm room, or going from a
warm shower into colder air can all cause itching.

Stress. Emotions such as frustration or embarrassment may lead to more itching and scratching.

Certain foods, such as
eggs, peanuts, milk, soy, or wheat products, if you are allergic to them. Up to 40% of children with
moderate to severe atopic dermatitis also have some type of
food allergy.1 But experts don't agree on whether foods can cause atopic dermatitis.

Excessive
washing. Repeated washing dries out the top layer of skin. This can lead to drier
skin and more itching, especially in the winter months when humidity is
low.

Symptoms

The main symptom of
atopic dermatitis is itching. The itching can be
severe and persistent, especially at night. Scratching the affected area of
skin usually causes a rash. The rash is red and patchy and may be long-lasting
(chronic) or come and go (recurring). The rash may:

Develop fluid-filled sores that can ooze fluid
or crust over. This can happen when the skin is rubbed or scratched or if a
skin infection is present. This is known as an acute (sudden or of short
duration), oozing rash.

Be scaly and dry, red, and itchy. This is known as a subacute
(longer duration) rash.

How bad your symptoms are depends on how large an area of
skin is affected, how much you scratch the rash, and whether the rash gets infected.

The areas most often affected are the face, scalp, neck, arms, and legs. The rash is also common in areas that bend, such as the back of the knees and inside of the elbows. Rashes in the groin or diaper area are rare. There may be age-related differences in the way the rash looks and behaves.

Babies (2 months to 2 years): The rash is often crusted or oozes fluid. It's most commonly seen during the winter months as dry, red patches on the cheeks.

Children (2 years to 11 years): The rash is usually dry. But it may go through stages from an oozing rash to a red, dry rash that causes the skin to thicken. This thickened skin is called lichenification. It often occurs after the rash
goes away.

For adolescents and adults, atopic dermatitis becomes less frequent and improves as you get older.

What Happens

Atopic dermatitis causes repeated attacks of itching
and rash that can become quite severe. It is most common
in babies and children. Some children outgrow it. But many people, especially teens and adults, continue to have
relapses or to have the condition, although not as severely.2 Also, a person may get atopic dermatitis
as an adult.

The condition may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.

Complications

Some people who have atopic dermatitis
get patches of lighter skin. This most often happens on the face, upper arms, or
shoulders. Chronic scratching or rubbing of the skin can also lighten or darken
skin color. When the condition has been successfully controlled, skin color returns to normal over time.

Skin infections can happen more often in people with atopic dermatitis. The skin may become red
and warm, and a fever may develop. Skin infections are treated with
antibiotics.

Eczema
herpeticum results when atopic dermatitis is infected with the
herpes simplex virus. This is the virus that causes
cold sores and
genital herpes. In this condition, the rash blisters
and may begin to bleed and crust. You may also have a high fever. This is a
serious infection, so contact your doctor right away.

What Increases Your Risk

The major risk factor for
atopic dermatitis is having a family history of the
condition. You are also at risk if family
members have
asthma,
allergic rhinitis, or other allergies.

When To Call a Doctor

Call your doctor if you or your
child has
atopic dermatitis and:

Itching makes you or your child irritable.

Itching is interfering with daily activities or with
sleep.

There are crusting or oozing sores, severe scratch marks,
widespread rash, severe discoloration of the skin, or a fever that is
accompanied by a rash.

Painful
cracks form on the hands or fingers.

Atopic dermatitis on the
hands interferes with daily school, work, or home activities.

Exams and Tests

Most cases of
atopic dermatitis can be diagnosed from a medical
history and a physical exam.

Allergy testing

Your doctor may recommend
allergy testing to find out what might be causing your atopic dermatitis. Allergy testing is most helpful for people
with atopic dermatitis who also have respiratory allergies or asthma.

Testing can also help find out if certain foods, such as eggs or nuts, are making the condition worse. Talk with your doctor about testing for allergies before making dietary changes.

If a specific allergen is
thought to trigger your atopic dermatitis, you and your doctor will discuss how
to eliminate it from your diet or environment while
closely observing and recording your symptoms.

Treatment Overview

Treatment for atopic dermatitis depends on the type of rash you have. Most mild cases can be treated at home with moisturizers—especially skin barrier repair moisturizers—and preventive care. Most of the time, rash and itching can be controlled within 3 weeks.

For more serious rashes, you will need to see your doctor for treatment. These rashes include:

An oozing rash, with fluid-filled sores that ooze fluid or crust over. You may have a skin infection.

For itching, treatment may include antihistamines. Also, taking baths with colloidal oatmeal (such as Aveeno) or applying wet dressings to the rash for 30 minutes several times a day may help.

In severe cases, hospitalization may be needed. A short
stay in the hospital can quickly control the condition.

What to think about

Counseling may be helpful for children and adults with atopic dermatitis. Talking with a
counselor can help reduce stress and anxiety caused by atopic dermatitis and
can help a person cope with the condition.

Prevention

If your baby is at risk for atopic dermatitis because you or other family members
have it or other allergies, these steps may help prevent a rash or reduce its
severity:

Take care of your skin

Avoid things that irritate a rash or make it worse, such as soaps that dry the skin, perfumes, and scratchy clothing or
bedding.

Avoid possible
allergens that cause a rash or make a rash worse, such as dust mites,
animal dander, and certain
foods.

Control itching and scratching

Keep your
fingernails trimmed and filed smooth to help prevent damaging the skin when
you scratch it.

Use protective dressings to keep from rubbing the
affected area. Put mittens or cotton socks on your baby's hands to help prevent
him or her from scratching the area.

Try coal tar preparations. When applied to the skin, they may
help reduce itching. But if your itching gets worse after using coal star, stop using it.

Avoid sun and stress

Exposure to natural sunlight can be helpful for atopic dermatitis, but it is important to avoid sunburn. Too much sun, sweating, and/or getting too hot also can irritate the skin. When you use a sunscreen, choose one for sensitive skin.

Medications

Medicines for
atopic dermatitis are used to help control itching and heal the rash. If you or your
child has a very mild itch and rash, you may be able to control it without
medicine by using home treatment and preventive measures. But if symptoms are
getting worse despite home treatment, you will need to use medical
treatment to prevent the itch-scratch-rash cycle from getting out of
control.

Medicine choices

Topical medicines, such as creams or ointments, are applied directly to the skin. Other medicines, such as oral corticosteroids or antihistamines, are taken as pills.

Topical corticosteroids are the most common and
effective treatment for atopic dermatitis. They are
used until the rash clears.

Calcineurin inhibitors
are topical immunosuppressants—medicines that weaken your body's
immune system. The U.S. Food and Drug Administration
(FDA) recommends caution when prescribing or using Elidel (pimecrolimus) cream
and Protopic (tacrolimus) ointment because of a potential cancer risk.3 The FDA also stresses that these medicines only be used as
directed and only after trying other treatment options. These medicines
aren't approved for children younger than 2 years of age.

Antihistamines are often used to treat atopic dermatitis itch. They can also help you
sleep when severe night itching is a problem. But histamines aren't always
involved in atopic dermatitis itch, so these medicines may not help all people. Don't give antihistamines to
your child unless you've checked with the doctor first.

Oral corticosteroids are used in severe cases when the rash covers large areas of the
body or when complications occur.

Coal tar applied to the
skin may help reduce itching. But this medicine should not be used on skin that is very irritated, because it can make your skin problem worse. Tar preparations are sometimes used to control the condition
after a stronger medicine has successfully improved atopic dermatitis.

Other Treatment

Other treatment for
atopic dermatitis includes light therapy and
complementary therapies.

Light therapy

Severe atopic dermatitis may be treated by exposing
affected skin to
ultraviolet (UV) light. There are two types of
ultraviolet light, called ultraviolet A (UVA) and ultraviolet B (UVB).

Too much sun exposure and light treatment (such as with
UVA or UVB treatments) increases your risk of skin cancer.

Complementary or alternative treatments

Complementary or alternative treatments may be helpful for treating atopic dermatitis. Some small studies showed benefit from these treatments. But there isn't clear scientific evidence to show that they help. Examples of complementary and alternative treatments for atopic dermatitis include:

Creams that are put on the skin. These creams contain St. John's wort or vitamin B12.

Chinese herbal therapy. But herbal therapies may also contain substances that may cause liver or heart problems.

If you are interested in these treatments, talk to your
doctor. Ask about the treatments' use, their effectiveness, and any possible interactions
related to other medicines you are taking.

Other Places To Get Help

Organizations

American Academy of Allergy, Asthma, and
Immunology

555 East Wells Street

Suite 1100

Milwaukee, WI 53202-3823

Phone:

(414) 272-6071

Email:

info@aaaai.org

Web Address:

www.aaaai.org

The American Academy of Allergy, Asthma, and Immunology
publishes an excellent series of pamphlets on allergies, asthma, and related
information. It also provides physician referrals.

American Academy of Dermatology

P.O. Box 4014

Schaumburg, IL 60168

Phone:

1-866-503-SKIN (1-866-503-7546) toll-free(847) 240-1280

Fax:

(847) 240-1859

Email:

MRC@aad.org

Web Address:

www.aad.org

The American Academy of Dermatology (AAD) provides information
about the care of skin. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool. Or you can read the latest news in dermatology. "SPOT Skin Cancer" is the AAD's program to reduce deaths from melanoma. There is also a link called "Skin Conditions" that has information about many common skin problems.

KidsHealth for Parents, Children, and
Teens

Nemours Home Office

10140 Centurion Parkway

Jacksonville, FL 32256

Phone:

(904) 697-4100

Web Address:

www.kidshealth.org

This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.

National Eczema Association for Science and
Education

4460 Redwood Hwy

Suite 16-D

San Rafael, CA 94903-1953

Phone:

(800) 818-7546(415) 499-3474

Fax:

(415) 472-5345

Email:

info@nationaleczema.org

Web Address:

www.nationaleczema.org

The U.S. National Eczema Association for Science and
Education works to improve the health and quality of life of people living with
atopic dermatitis/eczema.

National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health

NIAID Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Phone:

1-866-284-4107 toll-free

Phone:

(301) 496-5717

Fax:

(301) 402-3573

TDD:

1-800-877-8339

Web Address:

www.niaid.nih.gov

The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.

SkinCarePhysicians.org

P.O. Box 4014

Schaumburg, IL 60618-4014

Phone:

1-866-503-SKIN (1-866-503-7546) toll-free

Fax:

(847) 240-1859

Web Address:

www.aad.org

This Web site from the American Academy of Dermatology provides information on the treatment and management of skin diseases. There are links to information about acne, actinic keratoses, eczema, psoriasis, rosacea, skin cancer, and aging skin. There are also links to other resources, such as how to find a dermatologist in your area.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.